S288: A 9 YEAR REVIEW OF BLOOD TRANSFUSION PRACTICE AND ADHERENCE TO NICE GUIDELINES AT A DISTRICT GENERAL HOSPITAL, UK
Authors: N. Clayden, E. O’Donovan
Journal: HemaSphere (2022)

Background: Blood transfusions are common medical practice in the UK, with approximately 2.1 million blood products being issued by UK blood services in 2020. The Serious Hazard of Transfusion (SHOT) scheme reported that the risk of death and serious harm related to transfusions was 1 in 53,193 and 1 in 15,142 in 2020, respectively. Multiple complications can occur as a result of blood transfusions, with the most common cause of death being Transfusion Associated Circulatory Overload (TACO). Although low risk, there has been an increase in deaths related to blood transfusions from 17 deaths in 2019, to 39 deaths in 2020, in the UK, with 81.6% of adverse reactions and events being due to preventable errors. This stresses the importance of safe transfusion practice. Aims: To review the rates of blood transfusions from 2013 to 2021, and compare our adherence to NICE guidance. We analysed rates of transfusion, number of red blood cells (RBC) units per transfusion, haemoglobin levels and the incidence of iron deficiency anaemia (IDA) prior to transfusion. Methods: Data was collected retrospectively from patients’ records and the transfusion laboratory database at Surrey and Sussex healthcare Trust. Adults (>16 years old) who received inpatient or outpatient RBC transfusions from 2013 to 2021 were included (n = 53,941). We looked in further detail at the RBC transfusions from the first 2 weeks of December from 2014 to 2021 (n=546). Results: Figure 1 shows that there has been a significant decline in the number of RBC transfused from 2014 to 2021; an average gradient of -36.25 units per year (R2= 0.72). There has also been a decline in the average number of units per blood transfusion, with a downward trendline (gradient -0.15 RBC units/year, p= 0.001). There has been a significant increase in the percentage of single unit transfusions from 14% in 2014 to 65% in 2021; the trendline has a gradient of +7% / year (p=0.0009). The average haemoglobin at initiation of transfusion has remained relatively unchanged (69-78g/L), which is in line with NICE guidance. There is no improvement in transfusion of patients with IDA; defined as a low transferrin saturation (<20%). The percentage of these patients being transfused varying from 43% to 79%, with no significant trend over the years from 2014 to 2021 (p=0.71). Image:Summary/Conclusion: The total number of RBC transfused has significantly decreased over 9 years. However, there is a slight rise from August 2020, which may have been a result of expansion of the hospital bed base from 697 to 800 between years 2018-2021. It also may have been impacted by the COVID-19 pandemic. There is a decrease in the amount of RBC units transfused per patient. We are also encouraged to see a significant increase in the number of single unit transfusions, in line with NICE Guidance. We found there was no improvement in the number of patients with IDA being transfused (average 64%). This indicates that, depending on the clinical scenario, some patients may be receiving unnecessary blood transfusions. They may benefit from receiving iron replacement as an alternative treatment, thereby minimising exposing patients unnecessarily to the risks associated with blood transfusion. Appropriate management of IDA needs further work in the trust, and we have initiated an IV iron service over the last 18 months to improve this. Limitations of this study include using two weeks of the year to extrapolate for each year and data may have been skewed over the last two years due to the COVID-19 pandemic.